Provider Demographics
NPI:1659546083
Name:WATSON, JEANE PALMER (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEANE
Middle Name:PALMER
Last Name:WATSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 E PINETREE BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5390
Mailing Address - Country:US
Mailing Address - Phone:229-236-3338
Mailing Address - Fax:229-236-3337
Practice Address - Street 1:2024 E PINETREE BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5390
Practice Address - Country:US
Practice Address - Phone:229-236-3338
Practice Address - Fax:229-236-3337
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-27
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001066213ES0103X, 213E00000X
SC601213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA355230972AMedicaid
GA511I480052OtherINDIVIDUAL MEDICARE PTAN
GAP00884480OtherRAILROAD MEDICARE PROVIDER PTAN
SCAA39819277OtherINDIVIDUAL MEDICARE PTAN
SCDQ9090OtherRAILROAD MEDICARE GROUP PTAN
GAP00884480OtherRAILROAD MEDICARE PROVIDER PTAN
SCAA39819277OtherINDIVIDUAL MEDICARE PTAN
GA511G700902OtherGROUP MEDICARE PTAN
GADQ9092OtherRAILROAD MEDICARE GROUP PTAN
GA355230972AMedicaid